Healthcare Provider Details

I. General information

NPI: 1669189619
Provider Name (Legal Business Name): SEVEN HILLS OB-GYN ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12188A N MERIDIAN ST STE 250
CARMEL IN
46032-4426
US

IV. Provider business mailing address

PO BOX 772437
DETROIT MI
48277-2437
US

V. Phone/Fax

Practice location:
  • Phone: 317-571-1637
  • Fax: 317-571-9483
Mailing address:
  • Phone: 317-575-7304
  • Fax: 317-575-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN FERNANDEZ
Title or Position: VP, RCM
Credential:
Phone: 516-972-1568